In this episode of The Missing Link for SLPs podcast, I want to describe to you how my day’s playout as a medical speech pathologist in a variety of different settings.
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I have had over 25 years working in the medical speech pathology field, around the world, in a variety of settings.
I thought it would be fun just to explain how my day rolls out in each one, and the feeling, the flow and the excitement, or the non-excitement, of my days in different settings.
Medical Unit in a Level 2 Trauma or University Hospital in a Major City
So the first setting that I want to introduce you to as a speech pathologist is probably one of my favorite settings and it’s on a medical unit in a level two trauma hospital in a major city. My day starts off early when I climb into my car and I drive to a parking garage where I catch the bus into the city.
My drive to my bus is probably 10-15 minutes. My bus ride into the city is maybe 35minutes. I love the bus time because I put my headphones on – there’s Wi-Fi on the bus – so I read my emails, I cruise the internet, I listen to audiobooks, all of those things. I don’t talk on the phone, however, that’s considered quite rude on those buses. So, I get myself ready for my day on my bus ride in. I wear scrubs, I wear tennis shoes, I wear super comfortable clothing because I am going to be moving, moving, moving all day. When I arrive, I throw my purse in a drawer and I put my coat over the back of a chair where there may or may not be another coat, and throw my lunch into a small refrigerator. I go clockin’. After I clock in, I punch in on the computer and I pull up my schedule and print my schedule off.
Based on an eight hour day, I will usually have seven patients on my caseload. Some of them are evaluations and some of them are therapy sessions. I’ll start organizing my schedule for the day.
At the hospital I worked at, each of the patients come with a priority level. So the patients that are high on my priority list I will put those patients at the top of my schedule, and I’ll make sure that I go see those first. The reason why I need to see those first because in a medical setting, such as this, medical care is first and foremost, and there are so many activities going on for that patient during the day. Getting a speech pathology evaluation done is one of the many things that needs to happen during the day. But we can be lower on the totem pole simply because there are procedures that have to be done and those results need to be collected for medical decisions to be made. Ours is included in that. So those evaluations are at the top of the list, but I need to work around a very busy schedule. I then prioritize the rest of my patients. I try to group them together on the units when I can. And if not, that’s why I’m wearing my tennis shoes and I hit the ground running. When I first arrive on an inpatient floor, I’ll walk up to the nurse and I’ll talk to the nurse and see how the patient’s doing. I’ll introduce myself. I say, “Hi, I’m Mattie. I’m a speech pathologist and I’m working with your patient in room 224. Can you tell me how she’s doing today and what her schedule is like for the day?” The nurse will give me a brief rundown on how the patient is doing medically and the other procedures they have going on for the day. If there’s any more information she feels I need to know or if I can think of anything I need to ask, that exchange will take place at that time. I then walk into the patient’s room and introduce myself to the patient and the caregiver, explain who I am, why I’m there, how long what I’m planning on doing will take and then begin my evaluation or therapy session. I try to do as much charting as I can in the room with the patient’s comments and caregiver’s comments as appropriate. Following my evaluation, or therapy session, I’ll then step out in the hallway to finish my charting. Sometimes I will leave some of the trickier parts of the evaluation to be done in the hallway because I can then think and problem solve and take just the extra few minutes that I need to complete my whole picture evaluation. Interesting point is in trauma units and level two medical centers, you’re going to have a lot of medical activity going around you.
There’s going to be gurneys going up and down the hallway, there’s going to be a physician sitting beside you with possibly organs in a cooler waiting for an organ transplant. Family and nurses will going by, you’ll hear codes being called. You’ll hear announcements over the speaker system. Very busy, very active unit. I then finish my charting for that patient and then I move on to my next patient. If by chance one of my patients is not ready for a procedure or is NPO, pending a test or something, then I will move them to later on my list and then I’ll go to my next patient trying to double back and get all of my patients seen during the day. At the end of the day when I’ve seen everybody, I will then go back and put these patients back on the docket for the next day with their priority level so when the next speech pathologist comes in the next day, she’s ready to print, organize and go. These hospitals cover speech pathology seven days a week. So if you do get on a team at a Medical University, be prepared to work weekends and holidays.
Rural Hospital – On Staff and Private Practice
The next setting that I want to tell you about is working as a speech pathologist in a rural hospital. I have worked as a speech pathologist in this setting both as a private practice clinician, and as an on-staff speech pathologist. The difference is, as a private practice speech pathologist, I have my own private practice, where I carry my own insurance liability, I do my own taxes and I contract my care with the hospital versus being on staff, where everything is carried by the hospital. I’ll talk to the pros and cons of each one that you need to look at as you consider working in those situations. The day rolls out the same. To start, in a rural setting you will get a variety of patients and caseloads. You will have inpatient care and outpatient care. You may see adults and pediatrics. All I saw were adults at my particular inpatient hospital, but working at a rural hospital you’re going to get more of a mix. There’s usually only one or two speech pathologists at the most working in a setting like this, versus a university hospital, where there might be 10 or 12 SLPs on a day in an outpatient therapy setting. I have my own desk and my own cubby hole for my materials, a lot more relaxed laid-back atmosphere. At the rural hospital, I have specific start times and stop times. So usually I’ll clock in at nine. My first outpatient appointment arrives by 9:15. And then I hit the ground running, and I will have outpatient therapy sessions every 45 minutes and hour-long evaluations, and then30-minute inpatient treatments as needed. Some days I’ll have an inpatient, some days I won’t. Some days I’ll have video swallows for an inpatient. Some days I won’t. My outpatient video swallows are scheduled two per day. So I can get an average of 10 in a week. Those spots are always filled. The schedule at a rural hospital is a lot slower. When I walk up to the floor, it’s usually one floor away, versus the six or seven floors away at the University Hospital. I walk up onto the floor. Nursing is usually sitting, the atmosphere is relaxed and calm. I walk up, I know the nurse by name, she’ll greet me by name. She’ll know the patient I’m coming to see and she’ll tell me how that patient is doing. I will walk into the room and explain to the patient who I am, what I’m doing, how long this will take and then complete my evaluation or therapy session. Again, I try to document as much as I can in the room. It’s not hard to do. Then I step out and finish documentation, usually down at my own desk.
The third setting I want to explain is that is in an outpatient clinic. I drive to the outpatient clinic, park in the parking lot – no bus here – and walk right on in. I do share a cubby area with other speech pathologists. There’s four of us at this hospital. Two SLP’s specialize in pediatric and two of us specialize in adults. The schedule is very specific. I start my day at 7:00 and from 7:15 to 8:00 is my first session. 8:00 to 9:00 is an evaluation slot, 9:00 to 9:45 therapy session.9:45 to 10:30 therapy session. And the day clicks through like that. Therapy sessions are usually 45 minutes. Occasionally they’re 30 if my schedule is tight and someone’s wanting to squeeze in. Most of the time there are 45 minutes and evaluations are an hour. I will see eight patients to nine patients during a day. I have 15 minutes in the morning free for documenting and 15 free in the afternoon for documenting and I have a half an hour lunch. I work my way systematically through my patients. I arrived early in my day to prepare for all my patients during the day but I really disciplined myself that at the end of an evaluation when my plan of care is written, my goals are established. That’s when I pulled together the datasheets that I want to use and my treatment materials that I want to work with. So outpatient clinic is very structured and very linear as we work our way through the day.
The next setting is the home health setting. This was a job I worked when my children were younger because my day was so much more flexible. As a home health patient speech pathologist. I could drive into the home health office if I needed to pick up forms to pick up materials but most of the time, I would climb in my car and drive to my first patients house. Home health agencies will contract most of the time to speech pathologists some of the time we’re on staff, but our direct orders come from the Home Health office where we are given a list of patients and orders for evaluation and treatment. We will be working with a team. The nurse goes and does the intake prior to our first visit ever and then we work in around the other therapies. We will call the patient directly to schedule and on the phone. We’ll explain who we are and what we’re coming out for and approximately how long our visit will take. And then we hope that that patient remembers that we’re on their schedule, and they’re there when we show up. Sometimes they are. Sometimes they’re not, I would say probably 20% of the time they aren’t. I enjoy working as a home health speech pathologists because one, I don’t mind the drive too I enjoy walking into a person’s home and seeing who they are and what I can work with and seeing who they are and what I can work with because for example, if they are aphasic, then the items that we’re going to do are confrontational naming tasks with things right on their, their TV tray, and things that they keep beside them when they watch TV, their items in their room are right there. If there are dysphagia patient, well, then I get the thickener off of the cabinet and I take their favorite drink and I show them this is how you mix it. This is where you should be sitting. This is how you should be sitting up. So the environment is much more functional and the skills are easier to generalize in the home health setting. I will do evaluations and therapy sessions there. The atmosphere is much more laid back. And, chatty, I guess is the right word. You’re not under the stress of a medical setting. You’re in the patient’s home. They’re happy to see you. They’re happy to be home because they’ve just been discharged from somewhere. And they almost always welcome your advice and your recommendations.
Skilled Nursing Facilities (SNFs)
I’ve also worked in skilled nursing facilities, where I’ve been pulled on staff by a contract agency who contracts therapists to the skilled nursing facility. Most speech pathologists, physical and occupational therapists are not hired directly by the nursing facility itself. They are hired by an outside contract therapy company and that company is the one that drives the productivity rates and determines a lot of the setting that the speech pathologist works in. Here the schedule is flexible as well. I will walk into my day there, I’ll have a desk area that I share with other therapists. I will work off of an iPad, where I have my list of patients that I need to go see. In the settings I’ve worked at a SNF, the patients are not scheduled on a time, but rather there is the list of patients that I need to go see. And I need to get them in their evaluations and treatments during the day. I work around meals, I work around other therapists, I work around family activities and things such as that. It’s more of a laid-back setting in regards to therapy. However, the demands can be very, very high in regards to productivity, In this setting, I’ll see patients who are in a transitional care unit and both long term as, as well. So with a variety of level of patience, almost all of the patients that I see in this setting are 50 and above, definitely in the adult population.
Wrapping it up
So these are the main settings that I’ve worked in. And that’s how my days have played out in those different settings. I’ve explained how I start my day, how I end my day, how I get my schedule created. I’ve hopefully discussed the flexibility within each of these settings. The only thing that I haven’t discussed yet is activities that I do in addition to my speech language therapy. In the medical setting, the trauma level two setting, most of my time is spent in the trenches as a working speech pathologist. In these busy settings, I did not have the time to step out and serve on concussion groups or things like that. When I transferred to a rural hospital in an outpatient clinic that is when I had the time to then be a little bit more mindful of how I spent my day and say, I would love to send out a concussion team and work on improving our concussion intakes, or the dysphasia team where I’m training staff in the hospital as we transition to the IDDSI standards. So different settings, different challenges, different ways the days roll out. I hope you’ve enjoyed sharing my thoughts as I’ve recalled back on my different days as a speech pathologist in a variety of different medical settings.
As promised, my challenge of the week for you is this week, I want you to think about what medical setting would best meet you, your needs and interests. There are a variety of medical settings that a speech pathologist can work in which one interests you? Which one do you think you might enjoy working at?
“Successful people are not gifted, they just work hard, then succeed on purpose” by G. K. Nelson
Tip for Success
Be mindful of what you enjoy and what you don’t enjoy at work over the course of your career. You want to be doing what you enjoy over and over. So if you are doing something in your setting that you’re not so keen about, work on shifting that it’s in your control. Please head on over to FreshSLP.com and check out our updated website. Download the show notes, follow me on Instagram. We’re doing phenomenally well on Facebook so join our community!
Our next topic is discussing Impostor Syndrome and how to improve your confidence as a speech pathologist. I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge. Thank you for listening to The Missing Link for SLPs podcast!
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